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Despite the recent termination announcement from Aclaris Therapeutics, one of the three pharmaceutical companies that had been leading the way in the development of JAK inhibitor drugs for the treatment of all forms of Alopecia Areata hair loss, this suite of drugs is still being investigated by a number of other parties.

One of these, the School of Medicine at prestigious American Ivy League institution, Yale University, has released its latest findings from a trial exploring treating severe Alopecia Areata, such as Alopecia Universalis, with Xeljanz and oral minoxidil.

During a small-scale trial, it found this combination of oral hair loss treatments provided varying degrees of hair regrowth for almost all of the 12 patients studied.

Two-thirds experienced 75 per cent hair regrowth

One of the first janus kinase inhibition (JAK inhibition) discoveries relating to the treatment of autoimmune-related hair loss disorders – Alopecia Areata, Totalis and Universalis – was made by the team at Yale and related to Xeljanz.

Xeljanz is the brand name for the JAK inhibiting drug tofacitinib, which is made by Pfizer and is currently authorised to treat conditions including rheumatoid arthritis. It has been being trialled by various companies as a potential alopecia areata hair loss solution – in both oral and topical forms – since approximately 2014.

High strength minoxidil is currently used in its topical form to treat androgenetic alopecia – Male Pattern Baldness and Female Pattern Hair Loss – and is both MHRA-licensed and FDA-approved for this purpose. Its oral form is not authorised as a hair loss treatment though it does have the necessary regulatory sanctions as a treatment for high blood pressure.

Although it has only been approved and licensed for genetic hair loss, topical minoxidil is known to have various off-label applications for other hair loss conditions, including as an Alopecia Areata treatment when the condition affects the scalp only. Oral minoxidil is not widely recommended nor used to treat hair loss.

According to research published on 18th September 2019 in the Journal of the American Academy of Dermatology, and covered in the Healio Dermatology publication, 12 adults – 7 women, 5 men – were involved in this latest trial. It looked at results achieved over a period of at least six months.

Each had extensive scalp hair loss that was assessed prior to commencing treatment, and allocated a Severity of Alopecia Tool score which could then be compared to their scores at various intervals during the trial. Baseline hairloss levels were recorded as a median score of 99.5% across all trial participants, meaning they were all almost entirely bald.

The following results were noted by researchers, though the precise timeline for each is not yet available:

– 8 out of the 12 patients achieved 75 per cent hair regrowth to their scalp, represented by a SALT score of 75;

– 4 out of the 12 patients received a SALT score of between 11 and 74, meaning they saw scalp hair regrowth improvements of between 11 and 74 per cent.

Initial dosing involved all male patients being administered a Xeljanz 5mg tablet once each day and 2.5mg of oral minoxidil twice per day; all female patients were given a 5mg Xeljanz tablet once a day and 2.5mg of oral minoxidil once per day in order to minimise the potential for hypertrichosis – the development of excessive or unusual hair growth, such as facial hair.

However, of the eight patients observed to reach a SALT 75 score, seven used tofacitinib (Xeljanz) 5 mg twice per day and the eighth candidate in this result group had their Xeljanz dose increased to 10 mg twice per day after not responding to 5 mg twice daily over the 4 to 6 month period.

“Emerging as an important therapy for severe alopecia”

Tofacitinib (Xeljanz) being trialled as Alopecia Areata Treatment

Although the trial’s overall median final SALT score was 6.5 per cent, the team was keen to stress some significant individual responses and the importance of continuing to explore JAK inhibitors in relation to treating the types of alopecia areata which currently have few safe and effective therapeutic options.

According to Carlos G. Wambier, MD, PhD, of the department of dermatology at Yale and part of the team led by Dr. Brett King, “…one patient who had not achieved any hair regrowth 1 year prior with tofacitinib 11 mg extended release once daily for 3 months, experienced substantial hair regrowth over the first 3 months of combination therapy with the equivalent dose of tofacitinib, 5 mg twice daily…

Janus kinase inhibitors are emerging as an important therapy for severe alopecia areata and the possibility of increasing efficacy without increasing Janus kinase inhibitor dosage (and immunomodulation and cost of treatment) would be welcome.”

The potentially prohibitive cost of Xeljanz, including whether it would be carried by the NHS and covered by insurance companies in America has been an on-going concern since JAK inhibitors were first mentioned as potential Alopecia Areata treatments.

Another troubling factor, which may explain why the Yale team has looked to combining a JAK inhibitor with another hair growth drug, has been the current side effect profile of Xeljanz. Topical versions of the medication have been tested separately in order to help reduce the likelihood of these serious adverse events – ranging from headaches and upper respiratory tract infections, to shingles and an increased risk of tuberculosis – occurring.

As research to produce the first safe, tolerable and effective JAK inhibitor-based hair loss treatments continues, anyone concerned about sudden hair fall from their scalp or other areas of their body are advised to seek professional assistance as soon as possible.

Though a hair loss specialist will generally be able to help adults with the scalp-only form, those losing hair from their body or where they are under 16 years of age shoudl


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.
HairlossANSWERS - Click to Submit Your Query to Our Hair Loss Experts

Name: Sarah

Question: I am considering starting hair loss treatment with minoxidil but I have a cat and have heard minoxidil is harmful to cats. Please can you advise me if this is true and if there is any way to use it without risking my cat’s health?

Answer: Hi, Sarah. We’ve had several queries regarding high strength minoxidil use and cats over the years.

is minoxidil harmful to cats hair loss treatment advice belgravia centre clinic london

Given it would be unethical to test human hair loss treatment on cats, there is very little reliable scientific research published in medical journals about this.

However, an article from the Journal of Vetinary Emergency and Critical Care, which was published in 2004, reports on the death of two cats following their exposure to topical minoxidil liquid.

The abstract states: “Two cats with dermal exposure to topical minoxidil solution were identified from the ASPCA Animal Poison Control Center (APCC) files. Both cats were presented with lethargy and dyspnea within 36 hours of exposure. The cats were hypothermic, and had pulmonary edema and pleural effusion present on thoracic radiography. Both cats died despite supportive care. Necropsy of both cats confirmed pleural effusion and pulmonary edema and indicated cardiac compromise.”

What this does not tell us is how much minoxidil the cats came into contact with and what strength the hair loss solution was.

At Belgravia we always advise patients, with or without pets, to apply minoxidil at least one hour before they go to bed and to wash their hands their hands thoroughly after each application. This applies to all minoxidil formulations and, by doing so, allows sufficient time for the medication to be absorbed into the scalp with minimal residue.

This is important because any residue on the pillow means that, not only is some of the medication wasted as it is absorbed into the pillowcase rather than the scalp, but, when there is minoxidil residue on the pillow it may come into contact with the patient’s face, increasing the chances of skin irritation or the development of facial hair.

In cases where the patient is a cat owner, we would advise the same – apply at least an hour before going to bed to avoid residue on the pillow. You can also take the extra precaution of changing your pillowcase frequently, even daily, if you wish.

Symptoms of possible minoxidil toxicity in cats which you should be aware of include lethargy, weakness, a rapid respiratory rate, difficulty breathing, a lack of appetite and coughing.

It goes without saying that obviously you should not apply minoxidil to your cat or let it come into contact with your medication. But, should your cat accidentally touch minoxidil, I would advise washing the paw or fur immediately to remove any residue and take them straight to the vet as soon as possible.  

As you no doubt know, cats are very curious and can easily climb onto furniture, getting into even the smallest of spaces, so I would highly recommend storing your hair loss treatment safely, perhaps in a locked cupboard.

You can find further information on this subject, here, and, if you would like further details on women’s hair loss treatment, you may find an online or in-person consultation useful, where can discuss both your shedding concerns and any further queries regarding storage and application of your meds with a dedicated hair loss specialist.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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On 12th September 2019 it was made official that Aclaris Therapeutics Inc has dropped out of the race to develop the first JAK inhibitor-based treatment for all forms of Alopecia Areata.

The company’s official clinical trial registration for the open label study of its novel topical and oral hair loss solution, known as ATI-502, was updated with the news that it has decided to end its investigations.

This follows disappointing performance reports after ATI-502 Phase 2 trials for each iteration of autoimmune alopecia, from the mild scalp-only form, through to the more extensive Alopecia Totalis and Alopecia Universalis.

Portfolio of exclusive patents

Aclaris has been developing these janus kinase inhibition-based drugs since around 2016, when they announced a ‘strong commitment’ to this particular approach.

Aclaris Therapeutics

The company worked closely with Columbia University in America, which made some of the initial discoveries relating to how JAK inhibitors can be used to treat Alopecia Areata, and acquired many exclusive patent rights to a number of different members of this suite of drugs, licensed from both the Columbia Trustees and others.

What will happen to this impressive portfolio of patents remains to be seen.

Although the company also explored ATI-502 for the treatment of Male Pattern Baldness and Female Pattern Hair Loss, and developed a separate ATI-501 oral candidate for Alopecia Areata, its website suggests these also stalled at the Phase 2 stage.

Pfizer and Concert Pharmaceuticals battling it out

Concert Pharmaceuticals

With Aclaris now out of the picture, and the race to bring the first ever Alopecia Areata, Totalis and Universalis treatment to market that is FDA-licensed (and hopefully MHRA-approved, the MHRA being the UK equivalent of the FDA – America’s medical regulatory board) reaching its latter stages, two clear competitors have emerged.

Pfizer and Concert Pharmaceuticals are now the two leading pharmaceutical companies left with hats in this particular hair loss ring, and both have promising-looking propositions.

Pfizer

Pfizer is currently in Phase 3 trials for JAK inhibitor treatments for both adults and adolescents, from 12 years of age, with all forms of Alopecia, whilst Concert is preparing to enter the Phase 3 stage, having recently announced positive findings from its Phase 2 trials of over 18s.

The FDA is working closely with both companies, having awarded Concert Pharmaceuticals Fast Track status for its CTP-543 candidate, and granted Pfizer Breakthrough status for its PF-06651600 drug.

There are currently no officially recognised treatments for this condition and, whilst the scalp-only form has both Alopecia Areata treatment course options and tends to right itself naturally within up to 12 months, Alopecia Totalis and Universalis in adults and all forms in children have little in the way of safe and effective therapies available – yet.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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There are many well-established links between physical health and mental health; even on a basic level, the endorphins released as a result of exercise are known to improve our mood, our sleep and reduce stress – a known culprit behind many hair loss conditions.

Now an Australian study has looked specifically at the relationship between the effects of physical activity levels and the psychological well-being of people with hair loss caused by the chronic autoimmune disorder Alopecia Areata (AA).

exercise mental health feet trainers sneakers physical activitiy happy

This research follows a number of reports detailing how people with any form of Alopecia Areata have a higher risk of developing anxiety and depression.

Patients completed questionnaires

The study authors, from various institutions across Melbourne, note the specificity of this study was necessary due to the fact that “physical activity (PA) has been associated with better mental health outcomes in diverse populations [however] the association in individuals with AA has not been established. The aim of this study was to examine the associations between PA and mental health outcomes in individuals with AA to inform intervention strategies for this specific population.”

The team’s methodology involved a cross-sectional study conducted among 83 participants aged 40.95 ± 13.24 years who had lost more than half the hair on their scalp.

Each volunteer completed authorised International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Depression and Anxiety Stress Scale (DASS-21) questionnaires before their results were analysed to determine associations between physical activity levels and mental health outcomes.

When analysing the findings, researchers found that 81.9 per cent of these respondents did not meet guidelines – presumably Australian government guidelines though this is not stated – for physical activity.

Less physical activity linked to depression and anxiety

Results showed a clear correlation between the participants who did not meet physical activity guidelines and an increased propensity towards severe depression, moderate anxiety and mild stress.

Therefore, researchers concluded this suggests “increased PA participation in AA individuals with severe hair loss is associated with improved mental health status. Intervention efforts for this specific population should consider barriers and enablers to PA participation as they face challenges that differ from the general population.”

Life wait for storm dance in the rain quote inspirational

In the UK, the NHS gives the following advice on the amount of exercise adults aged 19 to 64 need to do, per week, in addition to advising all long periods of sitting are broken up with light activity:

“…at least 150 minutes of moderate aerobic activity such as cycling or brisk walking every week and strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)
Or: 75 minutes of vigorous aerobic activity such as running or a game of singles tennis every week and strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)
Or: a mix of moderate and vigorous aerobic activity every week – for example, 2 x 30-minute runs plus 30 minutes of brisk walking equates to 150 minutes of moderate aerobic activity and strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)…”

Group classes or team sports can also provide a valuable sense of camaraderie, as a number of amateur and professional sports people with Alopecia Areata have found. Famous examples include English rugby player Heather Fisher, footballer Jonjo Shelvey, basketball player Charlie Villanueva and former Olympian cyclist, Joanna Rowsell-Shand, who are all bald due to the more extreme Alopecia phenotypes.

These include Alopecia Totalis and Alopecia Universalis and, although Alopecia Areata treatment is possible for the scalp-only form, these more extensive iterations – which cause baldness to the head and from head-to-toe, respectively – currently have low success-rates for the limited hospital-based treatments available.

Whilst becoming an Olympic-level gold-medallist isn’t feasible for everyone, small steps every day can be beneficial to both mind and body – and especially so to those already known to be more prone to mental health issues.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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An oral treatment for all forms of the autoimmune disorder Alopecia Areata which causes varying amounts of hair loss, from bald spots on the scalp to complete baldness from head to toe, has reported great progress.

CTP-543, an investigational selective JAK inhibitor which specifically targets Janus kinases JAK 1 and JAK 2, is being developed by Concert Pharmaceuticals and has been granted Fast Track designation by the FDA.

On Tuesday 3rd September 2019 the topline results were released from the latest CTP-543 Phase 2 trial, during which higher doses were explored; the results have been welcomed as “highly encouraging” by hair loss specialists, including Dr. Brett King, Associate Professor of Dermatology at the Yale School of Medicine in America, who is known for his work in the area of JAK inhibition.

Robust results for both safety and efficacy

CTP-543 is a modified version of the JAK inhibitor rhuematoid arthritis drug, ruxolitinib (brand name: Jakafi), and has previously been trialled at lower doses.

This time 149 patients with a confirmed diagnosis of any form of Alopecia Areata, from the scalp-only phenotype to the more extensive Alopecia Totalis and Alopecia Universalis, which also involve the loss of facial and body hair, were given either 8mg of CTP-543 twice a day, 12mg of CTP-543 twice per day, or a placebo twice each day.

Results show “statistically significant differences” for both the 8mg and 12mg doses when compared to the placebo results, according to a Concert press release and data – as well as hair regrowth progress photos – which can be seen by clicking on the image below.

Concert Pharmaceuticals CTP-543 Alopecia Areata Treatment drug Phase 2 Trial Results 8mg 12mg doses

The average amount of hair loss in each patient at the start – their baseline measurement – was 88 per cent (where 100 per cent is total baldness).

The groups where 8 mg or 12 mg were administered twice each day saw far more patients achieve hair regrowth of over 75% and over 90% than the placebo group, at the 24 week mark. This was measured by improvements seen in their Severity of Alopecia Tool (SALT) score but was also reflected in patients own reporting via the Patient Global Impression of Improvement Scale data.

This information comes from the trial’s topline results, with complete study results expected to be presented in the near future.

In terms of safety and tolerability, the press release advises that both doses were generally well-tolerated. Of the five participants who discontinued the trial, three were taking the placebo and two were taking 8mg doses – none were taking the 12mg twice-per-day dosage.

Concert reports on adverse events during the trial, as follows:

“The most common (≥10%) side effects in the 12 mg CTP-543 dose group were headache, nasopharyngitis, upper respiratory tract infection, and acne. One serious adverse event of facial cellulitis was reported as possibly related to treatment; however, after a brief interruption, treatment was continued and this patient completed the trial. No thromboembolic events were reported during the trial.”

Preparing for Phase 3 trials with FDA guidance

James V. Cassella, Ph.D., Concert’s Chief Development Officer said of the news, “We are very pleased with these clinical results and continue to believe CTP-543 has potential to be a best-in-class treatment for alopecia areata… We are highly focused on the need for an effective and safe treatment for alopecia areata, and we plan to advance CTP-543 into Phase 3 testing next year.”

Indeed the next steps include preparing to talk to the FDA about CTP-543 Phase 2 end-point data and what the regulatory body wants to see from Phase 3 trials so these can be properly structured.

Concert stated they may consider looking at once a day dosing versus twice a day doses as having a strong efficacy and safety profile is the company’s main concern, which would also be likely to lead to a regulatory advantage.

In a follow-up phone call to discuss these findings, Concert’s representatives advised they are not planning on testing higher doses, though did note that many of the trial participants, especially from the 12mg CTP-543 cohort, have opted to continue treatment, and monitoring.

Therefore, they believe it is possible that this longer duration of treatment may increase the response rate of the current dosages – 8 and 12 mg.

In terms of Pfizer cross-trial comparisons, given Pfizer is the other front-runner when it comes to using JAK inhibitors to treat Alopecia Areata since Aclaris dropped out of the race – Concert was confident their work stacked up well, stating:

“We believe trial data is as strong as Pfizer’s. The 75 per cent change and 90 per cent change from baseline – we offer real benefit and have robust results compared to the data Pfizer has released.”

Whilst Alopecia Areata treatment can currently be beneficial for adults with the scalp-only form, there are no MHRA-licensed nor FDA-approved hairloss solutions for any of its iterations, and the more extensive they are, the lower the success rates tend to be. This is why the FDA in particular is lending its weight to helping bring about a safe and effective treatment to address this unmet need.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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A case study published in the Dermatology Practical & Conceptual journal has suggested medical professionals should consider Alopecia Areata a potential warning sign of other autoimmune disorders.

Alopecia Areata presents as patchy hair loss to the scalp, though in its more severe phenotypes it can also cause baldness to the entire head and/or body.

All forms are known to be autoimmune in nature and it is well-established that people with any autoimmune disorder are more likely to develop others.

Twins with Alopecia Areata and Thyroiditis

Hair loss, itchy scalps and thyroiditis

The study letter references a particular need to check for potential thyroid issues as Alopecia Areata may be a marker for issues such as autoimmune thyroiditis.

In this letter, published online on 31st July 2019, its authors, from the Dermatology Unit in the Department of Health Sciences of Magna Graecia University in Catanzaro, Italy, recount their experience with two identical 15 year old female twins (pictured).

Both developed Alopecia Ophiasis – a form of Alopecia Areata that causes a ‘snaking’ band of hairloss around the hairline. The first twin’s alopecia started at 4 years old; she then underwent treatment using systemic and topical corticosteroids from 14 years of age. The second twin presented with Alopecia Areata at age 14. Each twin’s hair loss is also accompanied by what the investigators refer to as “occasional itch”.

Following consultations and blood work, the researchers then diagnosed them both with autoimmune thyroiditis, with both showing “very high” autoantibody levels.

The case study letter advises, “treatment with oral betamethasone 2 mg/day was started for both twins for 1 month when they were 14 years old. It was then reduced to 2 mg twice a week in association with vasodilatory and antiseptic lotions of the scalp for 2 months. This therapy led to a partial remission of dermatological manifestations in both patients. An endocrinological consultation was also recommended to better evaluate thyroid malfunctioning.”

Links between Alopecia Areata and thyroid disorders

The Italian team’s personal observations led them to a conclusion which is essentially a warning to their peers that Alopecia Areata may be a biomarker for thyroid issues. They write:

Diagram Belgravia Centre Different Types of Alopecia Areata autoimmune hair loss
Areas affected by hair loss shown in blue

“Several studies have revealed a high prevalence of thyroid disorders in patients with AA. Screening for autoimmune thyroiditis and thyroid function should be done in all patients with these cutaneous disorders for the early identification of this disease…

Based on the literature data, which suggest a common activation of different immune patterns, and on the data obtained by our clinical case, we can say that AA should be considered a warning manifestation for other distinct diseases such as ones that affect the thyroid. In this unusual case, a genetic study to support the relationship between AA and autoimmunity may be useful.”

As they mention, this case study’s findings back those of larger scale research that has also established links between Alopecia Areata and autoimmune-based thyroid problems. These include Grave’s disease and Hashimoto’s thyroiditis.

Korean studies from 2017 found that, in a nationwide review, patients with Alopecia Areata were more likely to develop Graves’ disease or Hashimoto thyroiditis than those who did not. Additionally, people with the most severe forms of Alopecia Totalis or Alopecia Universalis, had a notably increased risk of developing either of these thyroid conditions.

Additional American research, released in October 2017, also suggested that specifically children should be screened for thyroid disorders if they present with Alopecia Areata.

Hair regrowth from the scalp-only form of Alopecia Areata will generally occur naturally within 12 months, though this is not usually the case for the more extensive forms. In either case, whether you intend to undergo Alopecia Areata treatment or not, it is worthwhile alerting your GP to the fact that you have developed this condition due to its potential ramifications on other areas of your health.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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HairlossANSWERS - Click to Submit Your Query to Our Hair Loss Experts

Name: Ryan

Question: I was playing football 2 months ago and I got hit by an elbow in my head very badly and a bump appeared after weeks the bump went down and no hair grew at the spot after, now I am wondering if I am experiencing permanent hair loss which I am worrying about because I am very young. Can my hair grow back?

Answer: Hi, Ryan. I am sorry to hear about your accident. I know it is easy to say but do try not to worry about this, especially as it is likely to be a temporary issue.

Next time you watch a Premier League football match, take a look at the players’ hair – you’ll often notice the odd professional footballer sporting a similar bald spot so you’re in good company!

Normal Hair Growth Cycle versus Hair Growth in Alopecia Areata

As you injured the scalp, I advise you to book a consultation with a dermatologist or hair loss specialist who can examine your scalp and discuss whether or not you would require any treatment.

It is possible the accident has caused temporary hair loss due to the injury in the area. The hair may have been pulled somehow, or, if the wound developed a crust during recovery, this may have led to the area losing hair temporarily. If this is the case, new regrowth is usually seen shortly after the skin recovers.

If you have developed Alopecia Areata (AA), characterised by a singular bald spot or multiple rounded, oval patches of hair loss to the scalp, this is slightly more complicated. Again though, the hair is still likely to regrow in most cases, with this occurring naturally within 12 months. There are also Alopecia Areata treatment courses which may help to promote accelerated hair growth, depending on how old you are.

Alopecia Areata is an autoimmune disorder which causes white blood cells to attack the hair follicles, disrupting the hair growth cycle and making them lose their hair. This results in sudden-onset hairloss.

The exact cause of AA is unknown, but it is known to be autoimmune in nature and, therefore, it may not be related to your injury. Common triggers include recent mental and physical stress, dietary deficiencies, infections, and occasionally genetic predisposition.

If the football injury you experienced caused a significant, sudden shock this could be a reason for AA, but as you have found a newly developed bald-looking patch on your scalp, it is worth checking with a dermatologist or, again – depending on your age – a hair loss specialist to get a confirmed diagnosis.

The prognosis of Alopecia Areata is very unpredictable – in some people the patchy hair loss will grow back, whilst in others it may not, or it may grow back then recur at a later date, or it may spread to other areas of the scalp, head or body. However, as I mentioned previously, good hair regrowth is seen in most cases.

Occasionally this new hair may appear white or pale when it first starts growing back, but this is nothing to worry about and generally its normal pigmentation will return later on.

Depending on the severity of the injury, it is worth noting that there is a chance the hair loss may be permanent, too. If there is deep damage of the skin impacting the hair follicles and forming scar tissue, this would mean follicles would no longer be active and would, therefore, be incapable of producing hairs. This is known as scarring alopecia or cicatricial alopecia and causes permanent hair loss due to this destruction of the hair follicles.

This is why it is important to have a consultation with a hair specialist or dermatologist who can examine the area thoroughly and advise you further as to the precise problem and recommend appropriate treatments for the condition based on their findings, your age and medical profile.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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The Mona Lisa is one of the most famous portraits in the world, with her cryptic smile inspiring many theories as to her identity and the cause of her unknowable expression.

Leonardo da Vinci’s masterpiece has long inspired artists from all genres, having recently found favour with a new audience since appearing in the Beyonce and Jay-Z video for The Carters’ ‘Apes**t’.

Now La Giaconda is back in the news for another reason… Researchers from Belfast City Hospital’s Department of Dermatology have spotted another facet to the sitter’s enigma – her hair loss.

Mona Lisa Receding Hairline hair loss frontal fibrosing alopecia art
The Mona Lisa, as featured in a music video by The Carters, Beyonce and Jay-Z

Receding hairline and lack of eyebrows

According to correspondence published in the British Association of Dermatologists’ journal of Clinical and Experimental Dermatology, researchers Victoria Campbell and Kevin McKenna, she displays classic signs of Frontal Fibrosing Alopecia (FFA).

FFA is a permanent hair loss condition which almost exclusively affects women. It belongs to a group of scarring conditions collectively known as Cicatricial Alopecia. It typically presents as a receding hairline in a thick, banded pattern, and is often accompanied by a loss of eyebrows.

This differs to the thinning hair at the temples, which can be found in cases of Female Pattern Hair Loss, as when the hair sheds, it does not ‘thin’, but rather exposes smooth, pale, bald skin which can be inches deep and tends to present in a fairly uniform pattern around the hairline.

Although there are currently no safe and effective hair loss treatments for FFA, new techniques such as PRP are being trialled.

In their 22nd August 2019 article (ref: doi: 10.1111/ced.14080), the Belfast team states, “This is the first report of features consistent with frontal fibrosing alopecia (FFA) found in the Mona Lisa: namely high forehead, receding frontotemporal hairline, and lack of eyebrows.”

The pair report how the painting has attracted significant attention from the medical community which has hypothesised diagnoses of hyperlipidaemia or hypothyrodism, based on her pallid appearance. “Given the higher prevalence of autoimmune conditions amongst patients with FFA, hypothyroidism may have coexisted,” they add.

An Example of Frontal Fibrosing Alopecia which Causes a Receding Hairline in Women
An Example of Frontal Fibrosing Alopecia

Was a hair styling practice to blame?

Campbell and McKenna cite another potential reason for the Mona Lisa’s frontal hair loss as being a Renaissance-era hair styling practice.

Not, as one might expect, tight hairstyles leading to Traction Alopecia, but something that has since died out and was known as ‘pseudoalopecia’.

This was where women’s eyebrows and hairlines would be shaved or plucked to create the illusion of a larger forehead. This intentionally-inflicted hair loss was done as the resuling look was considered to make women look more intelligent.

Whilst people know better than to attempt this practice now, when it comes to the Mona Lisa’s hairloss, whatever the truth of the matter is, we will never know. This is simply one more complexity to add to the mystery surrounding the world’s most visited painting, which is estimated to draw around six million visitors to her home at the Louvre in Paris, France, annually.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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Minoxidil is the only unisex hair loss treatment to be both MHRA-licensed and FDA-approved for the common hereditary condition, androgenetic alopecia (Male Pattern Baldness and Female Pattern Hair Loss).

However, it has also been seen to produce significant results when used off-label to treat patchy hair loss of the scalp caused by the autoimmune disorder Alopecia Areata.

Researchers from the Universidade Federal de São Paulo in Brazil have now conducted a systematic review into the use of topical high strength minoxidil to treat the scalp-only form of Alopecia Areata – the approach Belgravia takes – with promising results…

Effective with no adverse events reported

As part of a range of 80 therapeutic Alopecia Areata interventions being reviewed for safety and efficacy, topical applications of minoxidil were considered to be among the “most promising” for men, women and children, according to the Brazilian report.

This was published in the Journal of the European Academy of Dermatology and Venereology on 5th March 2019 and posted online in June 2019, though it was originally submitted in October 2018.

As to the methodology involved, corresponding author P.C.B. Freire writes: “An extensive search was conducted of international medical literature involving randomized clinical trials (RCTs) of AA interventions. RCTs were evaluated qualitatively and quantitatively according to the previously published protocol and for seven specific outcomes.” Continues below…

Minoxidil is a vasodilator which is believed to promote accelerated hair growth locally by opening the potassium channels, improving bloodflow to the area. It is a dose-dependent drug which is available over-the-counter in strengths of up to 5 per cent, though higher strength versions of the hair loss solution are also available.

The Brazilian study involved a meta-analysis of 5% strength minoxidil which, when compared to a placebo, was found to have “presented a significant difference in favor of 5% minoxidil with the moderate quality of evidence in children and adults with patchy AA (RR 8.37 [3.16–22.14], 95% CI)”. Furthermore, no severe adverse events were reported.

Following their review, researchers concluded, “Treatment of patchy AA with 5% minoxidil proved effective, and clinically and statistically safe in studies with limited sample size; quality of evidence was moderate”. They also noted that “Further studies with sound methodological quality, more participants and outcome observations lasting longer than 6 months are needed to address remaining uncertainties.”

Sudden hair loss which can recur

Alopecia Areata is both the name for the group of autoimmune disorders which cause sudden-onset hair loss, and the mildest form which solely affects the scalp. Other phenotypes include Alopecia Totalis and Alopecia Universalis, which present as total baldness of the head, including facial hair, and complete hairlessness from head to toe, respectively.

Normal Hair Growth Cycle versus Hair Growth in Alopecia Areata

Alopecia Areata is understood to affect 0.2 per cent of the global population, making it the most common hair loss condition worldwide, behind androgenetic alopecia. It can affect men, women and children of all races and occurs when the body mistakenly attacks hair follicles, disrupting the normal functioning of the hair growth cycle.

Although its precise cause is unknown, triggers are believed to include sudden shock or trauma, allergies, infections, hormones and genetic factors.

Where the scalp-only form is concerned, although Alopecia Areata treatment courses are available, normal hair growth will generally resume naturally within 12 months. Initially this regrowth may appear pale in colour, but this should also be a temporary problem.

Once the hair has regrown, it is still possible for the condition to recur in the future as it is known to wax and wane, with spontaneous hair growth and hair loss coming and going in some people. It has recently been shown that these recurrences may decrease over time, however.

For those with the more extensive versions, hospital-based therapies, including steroid treatment and immunotherapy, may be beneficial, though the success rate is relatively low. This is why the FDA has thrown its weight behind encouraging pharmaceutical companies to develop a safe and effective treatment for all forms of Alopecia Areata, granting Breakthrough designation or Fast Track status to a number who are showing solid progress in the area of JAK inhibiton.

It is hoped that the first JAK inhibitor treatments for Alopecia Areata, Totalis and Universalis may be made available by 2022 though there is still more work to do in order to meet necessary regulatory approval requirements ahead of this estimated release date.

In the meantime, adults with scalp-only Alopecia Areata may get treatment recommendations from a dedicated hair loss clinic, whilst children with any type and adults with the more severe forms should consult their GP or dermatologist for the appropriate referrals.


The Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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HairlossANSWERS - Click to Submit Your Query to Our Hair Loss Experts

Name: Farhan

Question: I had bald spot on my beard 9 months ago I noticed my is coming little bit but growing white not black I’m very upset my hair isn’t growing back black.

Answer: Hi, Farhan. The hair loss you describe sounds like a form of Alopecia Areata – an autoimmune disorder whereby the body attacks its own hair follicles.

The type which specifically affects the beard area is known as Alopecia Barbae.

Although its precise cause has not been established, it can be triggered by various factors such as stress, illness, infection or dietary deficiencies, for example. It may also be idiopathic, meaning the reason it presents is unknown.

Alopecia Areata Barbae - Bald Patches in the Beard
An example of Alopecia Areata of the beard, known as Alopecia Barbae

Researchers have a number of theories as to the cause of autoimmune alopecia, from a genetic link to neurological involvement, but – for now – no concrete pathogenesis or pathophysiology has been uncovered to explain it.

Whilst Alopecia Areata, in its mildest form, causes patchy hair loss in the form of rounded bald spots that appear on the scalp, Alopecia Barbae presents, in most cases, as a small round bald patch around the jaw or chin area.

Normal hair growth tends to resume of its own accord within a few months.

This regrowth can be lacking pigment at the start, appearing cream or white as a result, but its original pre-alopecia colouring often returns as the beard hair keeps growing.

Belgravia specialises in non-invasive hair loss solutions and hair growth supporting products, including Alopecia Areata treatment, however these are only recommended for conditions whereby the scalp is the only area affected.

We do not treat forms of alopecia which affect other areas of the head nor the body – such as Alopecia Totalis and Alopecia Universalis and do not recommend using hair loss treatments intended for topical scalp use, high strength minoxidil, for example, for the treatment of patchy beards.

As you are experiencing facial hair loss I recommend you consult your GP or a dermatologist so they can firstly confirm the diagnosis of Alopecia Barbae, and secondly, check for any other underlying medical conditions. Once they have done this, they should be able to discuss whether any treatment is appropriate and, if so, what is most suited to you based on your medical profile.

If it is only the discolouration of the hair regrowth in your beard that you are concerned about, as before, this should return to normal within a few months, but in the meantime you could consider dying it. That way, if it is done properly, it should blend in with the rest of your facial hair while you wait for its natural colour to return. If you are unsure about doing this, a reputable barber’s which offers this service – often listed as ‘beard grooming’ or ‘beard styling’ – should be able to help you.


Circ - Belgravia Centre Hair Loss Clinics LondonThe Belgravia Centre

The Belgravia Centre is an organisation specialising in hair growth and hair loss prevention with two clinics and in-house pharmacies in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the world. View our Hair Loss Success Stories, which includes the world’s largest gallery of hair growth comparison photos and demonstrates the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time to arrange a free consultation.

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